Can I change my mind?

When I drove up to the psych hospital with Kitty, she told me she'd changed her mind. She didn't want to go. I tried to reassure her, and reminded her that this was necessary. She was not happy, and that she needed the doctor's help to feel better. I reinforced that she had to tell the truth about her symptoms, the whole truth, or the doctors couldn't help her.

We spent the 4.5 hours of check-in time (no idea why it takes that long - especially since she's been there before, we'd faxed in tons of documents, they knew we were coming, and had a bed for us) with her completely shut down and snuggled in to me on an uncomfortable plastic loveseat. Every 45 minutes or so, someone would come and talk to one of us or both of us, we'd fill out some papers, and then they'd send us back to the waiting room. The TV was on an inappropriate channel so we sat with our backs to it and ignored it. The lobby was semi-crowded, but at least this time no one was bothering us and they even fed her dinner.

When I left her she gave me yet another big hug, and walked off to be checked over by the medical doctor.

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I talked to her on the phone the next day. She did not want to be there, but she sounded the same. Our conversation was brief because she had a stomach ache and wanted to go lie down. I told her I was sorry we couldn't come visit that night, but we'd see her the next afternoon.

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Yesterday on the way to a meeting with the psychiatrist at the phosp I talked to a friend of mine with a daughter that attends Bear's special school. Bear had confided in this family friend that he felt like we were deliberately keeping him out of the loop about his sister. I know last time she went to the hospital he felt a sense of guilt, as though it was his fault. This time he felt the same, probably partly because we've been working really hard with him, trying to keep him from teasing and pestering Kitty while she's in this emotionally fragile state. Will try to reinforce to him in therapy today that this isn't his fault, but he really cannot tease and pester her.

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Met with the psychiatrist at the phosp, and not really encouraged. They want to replace Kitty's Abil*fy and Trazad*ne with Clon*dine, and her Conc*rta with Foc*lin. This makes me really nervous, because Abil*fy is what finally got Kitty stable 2 years ago when this happened last. She's been on an admittedly mega high dose of it ever since. I talked to her therapist later and she is nervous as well. *sigh* My only reassurance was that at least it would happen there... probably. Of course they're just as likely to start the process and then send her home, like they did with the Proz*c at the last phosp.

Honestly I wasn't terribly upset by this until I met with Kitty afterward. I should have known what was coming when the pdoc asked us to talk about how Kitty ended up in the phosp. We talked about the day she ended up at the last hospital less than a month ago.

My version:, Kitty hadn't done her chores, and chose to sneak onto the computer anyway. It took me 20 minutes of "nagging" to get her off. Ponito got home from a playdate and I told him to do his chores. He said no, and then mentioned he had homework... on the computer. I let him get on and Kitty went ballistic so I put her on the "4 foot rule" until she could calm down, but she couldn't get regulated. It escalated to her punching me in the face.

Kitty's version: She was happily playing on the computer, and mean mom made her get off. Then Mom let horrible little brother play on it because she loves him more.

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Tell me again why I took Kitty to the hospital? Admittedly having a 150+lb growth permanently attached to my hip was draining, but I have to admit I was enjoying the loving part of her dependence. Yes, the meltdowns were awful... OK, I know why I took her, but... I CHANGED MY MIND!

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During our entire visit with Kitty she was perched on the edge of the seat, anxiously watching to see if the boy she was "interested" in was on his way out the door (he was being released). She gave us a quick, stiff hug when she was sure no one was looking - once when she arrived and once when she left. She wouldn't allow me to touch her. Her entire leg shook with the staccato tapping her foot was doing.

She spent the whole time railing at us about how we don't treat her like the 16 year old girl that she is, and that it's because we love the other kids more than her.

One proof that we don't love her: She NEEDS a Facebook page (she's not allowed to maintain contact with kids she meets in the phosp, but of course everyone breaks the phosp rule about it), EVERYone else in the house has a Facebook page except Ponito (We've changed the password on Bear's, but he still technically has one. I told her I don't actually have one, I just use Bear's. I've chosen to not notice Bob's). She promised me that this time she wouldn't be friends with Bear (biofamily found her last time because he was linked to them. When I discovered that, he lost his account again).

Kitty had also told Hubby her "best friend" was released earlier that day. I reminded her yet again that people she met in the phosp were people with issues, and as such were not capable of being good friends. This is why the phosp has the rule of no continued contact (which we enforce). She chose to pretend that she needed Facebook to keep in contact with school friends, and see this as yet more proof that we didn't love her.

We reminded her that we treat all our kids differently based on their needs, which has nothing to do with love, and actually very little to do with trust. She's heard all this a thousand times and can even answer me when I ask her why we do things the way we do, but she adamantly couldn't/ wouldn't process it.

Proof that we love the biokids more: Kitty brought up that Bob is starting to show signs of bipolar and therefore she and Bob should be treated the same. I tried to explain that even if Bob does become bipolar, Bob didn't have all the issues/ trauma that Kitty did growing up. Kitty missed out on a lot of things that Bob got, and now Kitty is having to play catch up and learn those skills. Plus, Kitty has proven over and over that she's not ready for the responsibilities yet, so she can't have the privileges. Kitty finally just admitted that she felt she deserved the privileges without the responsibilities.

So I tried a new analogy. She's 16 now and many 16 year olds can drive. So would it be right for me to give her the keys to car and send her to the store for me? She's never had a driving lesson and doesn't have a learning permit. Unlike Bear (who frequently sounds like Rainman saying, "I'm an excellent driver."), she admits that she doesn't know how to drive. Kitty agreed that this would be inappropriate and the police would probably get involved, but of course she chose to ignore the parallel to her not being prepared for the privileges she feels she's entitled to.

After all the conversations we've had about Super Sweet 16 birthdays, we've talked frequently about how kids who are given all the privileges they want frequently turn out to be unhappy, spoiled brats, and Kitty can parrot back what would happen if we gave her all of the privileges she wanted - whether she could handle them or not... but she was having none of it.

She remained shut down and agitated. When I confronted her on this, she said if she wasn't shut down she would cry (good insight at least). The group started lining up for dinner, and she was not able to participate in a conversation so we let her go. I'm sure she'll remember the meeting as us yelling at her. *sigh*

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After our visit I was pretty shook up. Kitty was convinced that she would be going home in the next couple of days, and while that was most likely not true with all the med changes they were proposing... there was no way I wanted to take this child home. She'd regressed so far back in her attachment and was so shut down and angry. Usually after leaving a phosp or RTC she's homesick and grateful to be home and we get a honeymoon. I don't get the feeling that is going to be the case this time.

I decided to ask to talk to a social worker there. Sort of tell someone "our side" of the story so that maybe in group she would not be allowed to reinforce this distorted perception. Her point of view sounds typical and even developmentally appropriate for a teenager (Parents don't understand me. Trying to be independent and they won't let me. Treat me like a younger child.), - problem is of course that she's NOT a teenager in the ways it really counts.

I talked to a part-time social worker for an hour. She doesn't do groups with Kitty, but promised to pass on the info. Who knows if it will make a difference.

Psychiatrist

"So how long have you had this unhealthy aversion to drinking from the toilet..."

I don't know how I feel about this psychiatrist. Bear was in an extremely surly mood after being forced to sit in ISS all day (in school suspension). The pdoc asked how things were going, and of course Bear said, "Fine." Smart pdoc dug a little and asked how school was going.

At first Bear just said, "Boring," but the pdoc specifically asked about referrals so Bear mentioned the one he got for "sharing an apple." (Dropped it to another student from a second story balcony into a hallway full of people). I hintingly cleared my throat. Bear chose to ignore me. I suggested he might want to mention the current issue. Bear said it was irrelevant (not his word) and had nothing to do with meds. I suggested we leave it up to the pdoc, since it suggested a lack of impulse control that his meds can address. The pdoc wanted to know too so he could decide for himself. Bear refused to tell, but finally said I could if I had to.

The pdoc said it had nothing to do with impulse control (which is BS! The initial event was obviously impulsive and all the rest happened to cover it up), and there were no meds he could recommend, then he promptly made a change to one of Bear's meds.

While he was entering stuff into the computer we all chatted a bit. The pdoc brought up the author Tobias Wolff who wrote his memoirs in This Boy's Life (later made into a movie with Leonardo DiCaprio as Wolff). More specifically the pdoc brought up the time when as a young teen Tobias Wolff and his friends would take the parking brake off parked cars at the top of big hills and watch the cars go crashing to the bottom of the hills, hitting other cars. Even Bear's caseworker protested the pdoc "giving Bear ideas," but the pdoc just said, "Bear already has ideas." Apparently his point was that this misguided, abused teen became an excellent writer, and that Bear had this capability.

The pdoc told another story with a good idea for mischief in it, but I don't remember what it was.

All Bear wanted to talk about was how he didn't want the school to help him get a job (they're talking about getting him life skills classes) and he didn't even want them to teach him anything. He wanted to drop out of school and get his GED. What he really wanted was to go back to the way things used to be (100-200 years ago!) so he wouldn't have to go to school and could hunt and fish in his "butt-flap" all day (Bear is part Native American).

I had to listen to Bear rant all the way home. It triggered my PTSD pretty badly.

Bear is refusing to go to the IEP (ARD) meeting today, because he's "already missed too much class (English)" and this is a hard class for him. We'll see if he shows up. I've found if you just ignore his protests he tends to go anyway. He's defiant, but not that defiant most of the time.

This should be an interesting ARD. We're supposed to be talking about:

• Bear's transition to life after high school (what he's going to be when he grows up)



• Bear's IEP - including one for Behavior



• His placement for the next semester (does he continue at the special school and for how much of the day?)



• We plan to ask for a parent/teacher conference with his regular high school teachers to talk about how best to help Bear (not letting him leave the classroom without an escort, reporting when he doesn't return, tardies, manipulations, breaking projects into smaller components...).

I'll keep y'all posted.

Breakthrough?

We were hoping that now that Kitty has friends at the new "school" that the meltdowns at home would decrease, but no such luck.

Got a call from the PDH's psychiatrist. She's been out of town for the last week and now the insurance company is pressuring her to make med changes (since obviously that's all that's wrong with Kitty. *sarcasm drip*). So she called me and started suggesting new meds?! I asked her if she'd discussed these with Kitty's psychiatrist (who Kitty can't see while she's in the PDH program, but has a lot more info about Kitty's past then I do and she has been in his care for over 2 years). Nope. She hadn't contacted him about Kitty at all. I mentioned that the psychiatric hospital had planned to change her meds until they discussed it with our psychiatrist, and changed their mind. I was fine with any changes she wanted to make - as long as she had discussed it with our psychiatrist first.

She'd said she'd call him that day (Bear had an appointment that evening so we knew she hadn't called), but she apparently did finally make the call this morning. We're going to be changing a lot of meds for Kitty. Wellbutrin for the depression (not supposed to make bipolar kids manic and decreases appetite so we might get rid of those extra 50lbs Kitty has put on since this Summer). She'll start that tomorrow morning. Early next week she'll start on Lithium for the bipolar and once that's in place we can start decreasing the extremely high dose of Trileptal Kitty is on - assuming it works of course. Then Adderall in place of the Concerta. Who knows?! Maybe this will help?!

We're still questioning whether or not the PDH is the right placement for Kitty. She is getting so much more aggravated during the day (stress is higher at this school because of the type of kids she comes into contact with), that she is coming home and taking it out on the family - much worse then when she was in public school. She is having a LOT more meltdowns at home. She has also started cussing a lot more (and not "naughty" words, but real cussing). Some of it could be the schedule change. Instead of leaving the house at 8am for school, she has to leave at 6:30am. That's a LOT less sleep, and with the added stress, she's probably not sleeping as well either.

She is often justifying her behavior with "I have issues" and "that's just the way I am." That does NOT make it acceptable behavior, but I'm not totally sure how to address it either.

Because of her PTSD (which is not really treatable by medication) once she is triggered into "Fight, Flight or Freeze" mode she is no longer rational and is reacting purely on instinct. If she were a small child and behaving like this (typical for those terrible twos!), I would just put her down for a nap, and try to eliminate whatever stress triggered the incident (food, tired, overwhelmed...). No long term consequences of course. The problem is, while at the time she is a small child emotionally... chronologically and in the eyes of the other kids (and later even herself) she is not a small child, and therefore should be held accountable for her actions. Every time she "gets away" with this type of behavior she sees it as permission to continue with it.

Because of the RAD (again, not treatable by medication), most of her issues are at home with her family of course, so all the extra therapy she's getting at the PDH is, I'm sure, helpful, but not with this issue. Once a week family therapy that's not conducted by someone who is very familiar with attachment disorders will not solve this "issue." I'm a little concerned that by admitting she has "issues" with family to this therapist that she will now reinforce her self-perception as someone who doesn't need/want a family. In other words it will become part of "who she is." Just like being a "girly girl" or "friendly."

In the 2 1/2 years we've had Kitty she HAS gotten attached to us. She does trust us not to hurt her (I think as evidenced by the fact that she will hit and scream at us - which she would never do with a stranger or Bear- aren't we lucky?!). She will occassionally admit that she loves me, sometimes will let me cuddle her and tell her that I love her, and will even sometimes that she loves Hubby, but it's rare. Most of the time though she denies that she wants to be part of the family, says she hates to be touched, and rages about how much everyone hates her. If we tell her we love her, the first word out of her mouth is "NO." Sometimes it's so hard to remember to tell her anyway. It's easy to convince someone you don't love them, but how do you convince them you do?! Just keep doing what we've been doing I guess.

Kitty has been in therapy more then half of her life. She knows and uses all the buzz words like, "I have anger management issues" or "I need to work on my behavior management." She knows what the therapists want to hear and she is EXCELLENT at changing the subject with tangents or other distractions.

I have no idea what our alternatives besides residential treatment would be, and I can't see residential treatment as being a good alternative for her. She is becoming more violent, but it seems to me that most of her issues are caused by her Complex PTSD (which being around agressive kids would aggravate even more, in addition to the fact that she's already afraid she's becoming "like her brother" - out of control and violent) and her RAD (which should alleviate significantly when she's not around the family as much, but certainly won't help her progress any).

Though keeping her at home is causing major problems too. Hubby is starting to feel like the warden again. Bear's PTSD is triggered by Kitty's meltdowns (last night he had to leave the house), and of course the other kids aren't getting a lot of attention (although they are not scared of Kitty like they were of Bear). I have to admit I'm highly frustrated because I feel a lot of pressure to "fix" everything. Mommy guilt makes me feel like there's a "right" way to handle situations or a "right" thing to say that would make it all better. My head knows that's impossible, but...

We had our second family therapy session today. Much of the session was just Hubby and I talking about our concerns to the therapist (who now reads this blog, "Hi, Mr. O!" - so I better watch what I say!). When Kitty did come in she started the session with this new quiet voice that I've only really heard her use with this therapist. He commented on the fact that he's never heard her use this voice before either.

Then, breakthrough! He started talking to her about an incident yesterday (she witnessed two girls coming to blows at the PDH) and what happened when she got home (meltdown with Grandma that involved cussing and yelling and then the same with Hubby and I that denegrated to hitting Hubby). The "real" Kitty started coming out. She talked about her hatred for our family, gave the therapist several "real life" examples of her vengeance issues (he'd been asking us about it), and generally showed him the side of her that only us as her family and a select few of her therapists get to see.

Not a very productive session, but for some reason I always feel a little better when other people see her acting like this, and how we respond (calmly). I often feel like "they" think it's all in our head or we are "provoking" it (by yelling at her or treating her badly). With Bear it was a lot easier because he was unable to control his behavior at all when he "lost it" so it wasn't always directed at us. Kitty puts up the charming, friendly facade that is so typical for RAD kids.

So now what? What are our options?

1. We can put her back in public school where at least there was less stress at school. She will continue to fall apart, but it probably won't be as fast.

2. We can stick it out with the PDH and hope that the med changes will take effect quickly.

3. We can move her to residential treatment and hope that the neurological assessments make a big difference (and she won't be home while they make med changes which would be easier on the family).

4. ???!!! I've thought about an attachment intensive, but she has so many other issues that would make that so complicated. And more importantly (unfortunately) this would cost a lot of money and time that we just don't have. I haven't found a local therapist willing to do an intensive. Most of the few I can find on the internet are in Colorado (not just a hop, skip and a jump from here!). I do have family in CO, but the other 3 kids need us too. Not to mention that she is now 14 so attachment therapy at this age is VERY difficult. Of course emotionally/ developmentally she is only about 4-5 years old so maybe that helps.

Purplewalls - thanks for the suggestion regarding TinkerBear. I am strongly considering it! Say hi to the ladies at the C&C board for me. In my 3 computer change this year I managed to lose my user name and password and I can't get it to e-mail it to me. *sigh* Will keep working on it! Do you know if the user name is an e-mail addy or a name? That would narrow down the choices some.

Marythemom

Pharmacies

AAAARRRGGGHHH!

So after the kids p-doc appointment I went to the pharmacy to drop off their new prescriptions. They needed a couple of refills, we made some changes to Kitty's meds and the rest needed to go on file.


I always return the bottles to the pharmacy when asking for a refill (for one thing I don't need 20 bottles a month). When filling the kids med box for the week, I just set aside the bottles when they are empty then take them all to the pharmacy. Recently we've been having so much trouble with the pharmacy that I've started putting pennies in the med box for each missing pill. That way I won't give them the meds and think they have them all.


So on Monday I dropped off 2 prescription bottles and said I would pick them up the next day. The person said both had no refills so it would have to be called in. No biggie, I always have at least a 3 day supply when I drop them off. So when I came to pick up the meds, they said that Kitty's Triliptal had no refills. It wasn't on the prescription sheet I had (I assume the doctor had called it in earlier so hadn't wanted to put it on the prescriptions). They wouldn't loan me any and I was completely out. Luckily, Bear takes this too so I was able to borrow from his bottle.


They gave me a bottle of Provigil for Bear with only a 3 day supply in it because they didn't have any more on hand. More would be coming soon and they would call me. I was pretty sure I needed more Amantadine, but they insisted that I was mistaken. I guess I need to start writing down what I take in. That would prevent what happened with Kitty's Zoloft last month too. *sigh*


So I went home and checked. I had Provigil coming out my ears and needed Amantadine. I called the pharmacy and we argued for a few minutes. She said she had no idea why they'd filled the Provigil (this has happened before), but she insisted we'd just picked up the Amantadine on the 17th. That sounded familiar, but nonetheless we were out of Amantadine. Finally she realized that when they'd filled the Amantadine on the 17th, they'd only given us a 2 week supply because that was all the p-doc approved until the next office visit. I asked if the prescriptions I just dropped off had Amantadine included. Why yes, it did!


So hopefully I can pick up Bear's Amantadine, Kitty's Seroquel increase, and I'll call in Kitty's Triliptal to the p-doc so he'll fax his approval. Why does this have to be so complicated?!!


The good news is that Bear is very stable and doesn't have to see the p-doc for 6-8 weeks instead of monthly!! The bad news is that Kitty is still not stable - so we won't be removing the last bit of Geodon just yet. We'll increase her Seroquel substantially first before we try removing it. We have a great p-doc who believes what I'm saying (refreshing!!), but I was still glad that he was able to see Kitty being her usual slightly obnoxious self so he knows I'm not just a big whiner.


Kitty wouldn't let me kiss her goodnight last night. She's in full 'don't touch me' mode. *sigh*


Mary